Monitoring Sound Levels and Soundscape Quality in the Living Rooms of Nursing Homes: A Case Study in Flanders (Belgium)

Effect of Soundscape Augmentation on Behavioral Symptoms in People With Dementia: A Pilot Randomized Controlled Trial

Background and Objectives

Sound is an important environmental factor that influences the expression of behavioral and psychological symptoms of dementia. Recent research on the effect of soundscape has shown promising results in improving environmental impact on people with dementia. However, no controlled studies have aimed to quantify the effects of soundscape intervention on resident outcomes. The aim of this study was to assess the feasibility and impact of a soundscape intervention on people with dementia and behavioral symptoms.

Research Design and Methods

Pilot single-blind repeated-measures randomized controlled trial of an augmented soundscape intervention. Participants were people with dementia in a hospital-based specialized dementia unit. Participants were randomized to an augmented soundscape intervention delivered in their room in the morning and evening or treatment as usual, with 2 baseline weeks and 4 weekly post-randomization assessments of the primary and secondary behavioral outcomes.

Results

The soundscape intervention was feasible in terms of recruitment, retention, and delivery of the intervention. There were improvements in the neuropsychiatric inventory total scores over time in both groups (-5.89, 95%CI -8.45 to -3.28, p < .001), but no differences between groups. There were no significant group, time, or group × time differences for the Pittsburgh Agitation Scale (PAS) total score. For the PAS-resisting care subscale, there was a significant group × time difference, with a greater reduction in the soundscape group over the study period (-0.81, 95% CI -1.59 to -0.03, p = .042).

Discussion and Implications

In this pilot study, soundscape augmentation was a feasible and effective nonpharmacological approach to reducing resistance to care in people with dementia, although it did not improve neuropsychiatric symptoms more globally. Further studies with larger samples and of longer duration are needed to investigate the long-term effects of augmented sonic environments on people with dementia.

Clinical Trials Registration Number

NCT04809545.

A study on the influence of dominant sound sources on users' emotional perception in a pediatric dentistry clinic

Introduction

Soundscape in dental clinics has varying degrees of impact on the emotions of healthcare workers and young patients. Emotions such as restlessness, anxiety, anger, and nervousness are commonly found among dental healthcare workers. Pediatric dental clinics are an important part of dental clinics, but there is a lack of research on the soundscape within pediatric dental clinics.

Methods

This study focuses on a typical pediatric dental clinic, using a combination of field questionnaires and objective measurements. It aims to determine the impact of dominant sound sources on the emotional perception (nervousness, restlessness, anger, fear, pain) and hostile emotional responses of users in the pediatric dental clinic.

Results

In the soundscape of pediatric dental clinics for young pediatric patients, users experience negative emotional perceptions (nervousness, restlessness, anxiety, anger, fear, and pain) and emotional responses of hostility. The dominant sound sources can be divided into two categories: dental (dental drill, air-water syringe, and saliva ejector) and nondental (children crying). Under the influence of dental dominant sound sources, there was a significant negative correlation between the emotional perceptions of healthcare workers and their negative emotional perceptions (p  <  0.05). Conversely, for young pediatric patients aged 0-11  years, a significant positive correlation was observed between their emotional perceptions and negative emotional perceptions. The mean perceived degrees of nervousness and fear in young pediatric patients were 1.82 and 1.71 times stronger, respectively, than those observed in healthcare workers. Under the influence of non-dental dominant sound sources, the average degree of emotional perception among healthcare workers was 0.71 higher than that of young pediatric patients, and anxiety perception was significantly enhanced (p  <  0.05). The mean degree of nervousness perception was 1 point higher in healthcare workers compared to young pediatric patients, restlessness perception was 1.1 stronger, and there was a presence of mild pain perception. In terms of demographic/social factors, age, occupation, and years of work significantly affected the perceptions of fear and restlessness among healthcare workers, while age had a significant impact on the emotional reaction of hostility in young pediatric patients.

Discussion

The results of this study indicate that the soundscape is an important factor in creating a comfortable treatment environment in pediatric dental clinics. Healthcare workers and young pediatric patients are significantly affected by the dominant sound sources in the clinic, and these effects are closely related to demographic and social factors such as age, profession, and years of experience. This finding can provide more targeted methods and strategies for the design and creation of soundscapes in dental clinics.

The Influence of Everyday Acoustic Environments on the Challenging Behavior in Dementia: A Participatory Observation Study in Nursing Homes

Challenging behavior (CB) is a group of behaviors, reactions and symptoms due to dementia, which can be challenging for the caregivers. The study aims to research the influence of acoustics on CB in people with dementia (PwD). An ethnographic method was used to study the daily life of PwD in their nursing homes with a specific focus on how people react to everyday environmental sounds. Thirty-five residents were included in the sample based on purposeful, homogeneous group characteristics and sampling. Empirical data were collected using 24/7 participatory observations. The collected data were analyzed using a phenomenological-hermeneutical method: a naïve understanding, a structural analysis and a comprehensive understanding. The result shows that the onset of CB depends on whether the resident feels safe and is triggered by an excess or lack of stimuli. The excess or shortage of stimuli and whether and when it affects a person is personal. It depends on various factors, the person's state and the time of day, the nature of the stimuli, familiarity, or strangeness is also a determining factor for the onset and progression of CB. The results can form an essential basis for developing soundscapes to make the PwD feel safe and reduce CB.

Research on Acoustic Environment in the Building of Nursing Homes Based on Sound Preference of the Elderly People: A Case Study in Harbin, China

Nursing homes are the facilities where the elderly conduct their daily activities. This may lead to a complicated acoustic environment which would potentially affect the ability of the elderly to function. In this study, the main indoor public space of a nursing home in Harbin was taken as the research object, and the methods of field observation, sound measurement, and questionnaire survey were used to explore the sound perception and preference of the elderly. The results revealed that in terms of the temporal and spatial distribution of sound pressure level (SPL), the unit living space had the highest SPL, which was above 60 dB (A). The reverberation time (RT) of the unit living space, medical and health care center corridor, was 2.15 and 2.13 s, respectively, at a frequency of 1,000 Hz, which was within the discomfort range. The results also revealed that an acoustic environment had a strong correlation with humidity and a weak correlation with temperature. However, no significant correlation could be assessed with a luminous environment. The elderly people were generally willing to accept the natural sound sources. The factors of gender and offspring numbers had no significant impact on the evaluation of acoustic environment comfort, whereas marriage and income status affected the comfort. This study may help improve the quality of life of the elderly in the nursing home and provide a reference for the construction and design of pension facilities.

Combining Music and Indoor Spatial Factors Helps to Improve College Students' Emotion During Communication

Against the background of weakening face-to-face social interaction, the mental health of college students deserves attention. There are few existing studies on the impact of audiovisual interaction on interactive behavior, especially emotional perception in specific spaces. This study aims to indicate whether the perception of one's music environment has influence on college students' emotion during communication in different indoor conditions including spatial function, visual and sound atmospheres, and interior furnishings. The three-dimensional pleasure-arousal-dominance (PAD) emotional model was used to evaluate the changes of emotions before and after communication. An acoustic environmental measurement was performed and the evaluations of emotion during communication was investigated by a questionnaire survey with 331 participants at six experimental sites [including a classroom (CR), a learning corridor (LC), a coffee shop (CS), a fast food restaurant (FFR), a dormitory (DT), and a living room(LR)], the following results were found: Firstly, the results in different functional spaces showed no significant effect of music on communication or emotional states during communication. Secondly, the average score of the musical evaluation was 1.09 higher in the warm-toned space compared to the cold-toned space. Thirdly, the differences in the effects of music on emotion during communication in different sound environments were significant and pleasure, arousal, and dominance could be efficiently enhanced by music in the quiet space. Fourthly, dominance was 0.63 higher in the minimally furnished space. Finally, we also investigated influence of social characteristics on the effect of music on communication in different indoor spaces, in terms of the intimacy level, the gender combination, and the group size. For instance, when there are more than two communicators in the dining space, pleasure and arousal can be efficiently enhanced by music. This study shows that combining the sound environment with spatial factors (for example, the visual and sound atmosphere) and the interior furnishings can be an effective design strategy for promoting social interaction in indoor spaces.

Acoustics for Supportive and Healthy Buildings: Emerging Themes on Indoor Soundscape Research

The focus of the building industry and research is shifting from delivering satisfactory spaces to going beyond what is merely acceptable with a wave of new research and practice dedicated to exploring how the built environment can support task performance and enhance people’s health and well-being. The present study addresses the role of acoustics in this paradigm shift. Indoor soundscape research has recently emerged as an approach that brings a perceptual perspective on building and room acoustics in order to shape built environments that “sound good” according to building occupants’ preference and needs. This paper establishes an initial discussion over some of the open questions in this field of research that is still in an embryonic stage. A thematic analysis of structured interviews with a panel of experts offered a range of perspectives on the characterization, management, and design of indoor soundscapes and health-related outcomes. The discussion pointed out the importance of both perceptual and multisensory research and integrated participatory design practices to enable a holistic view regarding the complex building–user interrelations and the design of just cities. Soundscape methodologies tailored to the peculiarities of indoor soundscapes can help to measure and predict the human perceptual response to the acoustic stimuli in context, thus reducing the risk of mismatches between expected and real building experiences. This perceptual perspective is expected to widen the scientific evidence for the negative and positive impacts of the acoustic environment on human health, well-being, and quality of life. This will support prioritizing the role of acoustics in building design and challenge many current design practices that are based on a noise control approach.

Acoustic Design Criteria in Naturally Ventilated Residential Buildings: New Research Perspectives by Applying the Indoor Soundscape Approach

The indoor-outdoor connection provided by ventilation openings has been so far a limiting factor in the use of natural ventilation (NV), due to the apparent conflict between ventilation needs and the intrusion of external noise. This limiting factor impedes naturally ventilated buildings meeting the acoustic criteria set by standards and rating protocols, which are reviewed in this paper for residential buildings. The criteria reflect a general effort to minimize noise annoyance by reducing indoor sound levels, typically without a distinction based on a ventilation strategy. Research has developed a number of solutions, discussed here, that try to guarantee ventilation without compromising façade noise insulation, but, currently, none have been adopted on a large scale. This concept paper highlights the main limits of the current approach. First, a fragmented view towards indoor environmental quality has not included consideration of the following acoustic criteria: (i) how buildings are designed and operated to meet multiple needs other than acoustical ones (e.g., ventilation, visual, and cooling needs) and (ii) how people respond to multiple simultaneous environmental factors. Secondly, the lack of a perceptual perspective has led acoustic criteria to neglect the multiple cognitive and behavioral factors impinging on comfort in naturally ventilated houses. Indeed, factors such as the connection with the outside and the sense of control over one’s environment may induce “adaptive acoustic comfort” opportunities that are worth investigating. The mere use of different sound level limits would not be enough to define criteria tailored to the complex user–building interaction that occurs under NV conditions. More holistic and human-centered approaches are required to guarantee not only neutrally but even positively perceived indoor acoustic environments. For this reason, this paper considers this apparent conflict from a soundscape viewpoint, in order to expose still unexplored lines of research. By underpinning a perceptual perspective and by contextualizing it, the indoor soundscape approach provides a framework capable of overcoming the limits of the traditional noise control approach. This could provide the opportunity to foster a wider adoption of NV as a passive design strategy that enhances user health and well-being, while enabling low-cost, and low-energy cooling and ventilation, thereby contributing to current climate change challenges.

Designing Supportive Soundscapes for Nursing Home Residents with Dementia

Sound and its resulting soundscape is a major appraisal component of the living environment. Where environmental sounds (e.g., outdoor traffic sounds) are often perceived as negative, a soundscape (e.g., containing natural sounds) can also have a positive effect on health and well-being. This supportive effect of a soundscape is getting increasing attention for use in practice. This paper addresses the design of a supportive sonic environment for persons with dementia in nursing homes. Starting from a review of key mechanisms related to sonic perception, cognitive deficits and related behavior, a framework is derived for the composition of a sonic environment for persons with dementia. The proposed framework is centered around using acoustic stimuli for influencing mood, stimulating the feeling of safety and triggering a response in a person. These stimuli are intended to be deployed as added sounds in a nursing home to improve the well-being and behavior of the residents.

Assessment Methods and Factors Determining Positive Indoor Soundscapes in Residential Buildings: A Systematic Review

The design of an indoor acoustic environment positively perceived by building occupants requires a perceptual approach to be adopted in order to define what makes it sound good. Soundscape standards ISO 12913 have been introduced to assess how the acoustic environment is perceived, in context, by people. According to the standards, a straightforward characterization of a soundscape as positive is currently possible only through measurements by persons, because of a current gap in linking perceptual metrics to acoustic or psychoacoustic measurements. In addition, despite applying also to indoor contexts, methods and perceptual metrics described by the standards have been mainly derived from studies related to outdoor urban environments and it is not clear whether they could be directly applied indoor. For this reason, a systematic review was performed to investigate: (i) Data collection methods used in the literature for indoor residential soundscapes and (ii) factors, output of such methods, that characterize them positively. For this purpose, a systematic review has been conducted in accordance with the PRISMA guidelines (preferred reporting items for systematic reviews and meta-analyses) guidelines. The Scopus database was searched for peer-reviewed journal papers published in English, between 1 January 2009 and 24 June 2019, including: (1) field or laboratory studies relevant to residential buildings and (2) studies assessing factors that influence the perception by building users of indoor acoustic environments. The search excluded studies related to: (a) Speech perception issues; (b) noise-induced sleep disturbance; (c) acoustic perception by hearing impaired building users; (d) perception of vibrations or impact sounds. The search returned 1087 results. After the screening process, 37 articles were finally included. Given the differences in methodologic approaches, a quantitative meta-analysis could not be performed, and a qualitative approach was adopted instead. A large part of the selected literature reflected a general effort of minimizing noise annoyance by reducing noise exposure and, in particular, noise levels. Questionnaires and guided interviews were used to capture people’s perception, while the adoption of soundwalks and non-participatory behavioral studies did not emerge in the review literature and need further investigation. The evaluation of a variety of auditory sensations both in their positive and negative dimensions, beyond annoyance, would be required to explore the positive perceptual potential of sounds. Besides sound level, a variety of factors related and unrelated to the acoustic environment were found to affect perceptual outcomes and a framework of evaluation has been proposed as a reference for future assessments. Results encourage the integration of soundscape methodologies into IEQ research, in order to enhance user health and well-being.

Accurate Indoor Sound Level Measurement on a Low-Power and Low-Cost Wireless Sensor Node

Wireless sensor networks can provide a cheap and flexible infrastructure to support the measurement of noise pollution. However, the processing of the gathered data is challenging to implement on resource-constrained nodes, because each node has its own limited power supply, low-performance and low-power micro-controller unit and other limited processing resources, as well as limited amount of memory. We propose a sensor node for monitoring of indoor ambient noise. The sensor node is based on a hardware platform with limited computational resources and utilizes several simplifications to approximate more complex and costly signal processing stage. Furthermore, to reduce the communication between the sensor node and a sink node, as well as the power consumed by the IEEE 802.15.4 (ZigBee) transceiver, we perform digital A-weighting filtering and non-calibrated calculation of the sound pressure level on the node. According to experimental results, the proposed sound level meter can accurately measure the noise levels of up to 100 dB, with the mean difference of less than 2 dB compared to Class 1 sound level meter. The proposed device can continuously monitor indoor noise for several days. Despite the limitations of the used hardware platform, the presented node is a promising low-cost and low-power solution for indoor ambient noise monitoring.

Dental Environmental Noise Evaluation and Health Risk Model Construction to Dental Professionals

Occupational noise is unavoidably produced from dental equipment, building facilities, and human voices in the dental environment. The purpose of this study was to investigate the effect of occupational noise exposure on the dental professionals' health condition. The psychoacoustics approach noise exposure assessment followed by the health risk assessment was carried on at the paediatric dentistry clinic and the dental laboratory in the Prince Philip Dental Hospital of Hong Kong. The A-weighted equivalent sound level, total loudness, and sharpness values were statistically significantly higher for the noise at the laboratory than that at the clinic. The degree of perceived influences and sharpness of noise were found to have the impacts on the dental professionals' working performance and health. Moreover, the risk of having a bad hearing state would a have 26% and 31% higher chance for a unit increment of the short-term and long-term impact scores, respectively. The dental professionals with the service length more than 10 years and the daily working hours of more than eight showed the highest risk to their hearing state. The worse the hearing state was, the worse the health state was found for the dental professionals. Also, the risk of dissatisfaction would be increased by 4.41 and 1.22 times for those who worked at the laboratory and a unit increment of the long-term impact score. The constructed health risk mode with the scientific and statistical evidence is hence important for the future noise management of environmental improvement.